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Less invasive percutaneous closure of persistent arterial duct in children below 10 kilos
Jacek Kusa1, Małgorzata Raś2, Paweł Cześniewicz2
1Regional Specialist Hospital, Research and Development Center in Wroclaw, Medical University of Silesia in Katowice, Poland.
Insights
This study introduces a new transvenous method for closing persistent arterial ducts (PDA) in small children, reducing risks associated with arterial puncture. The procedure proved safe and effective for all patients, achieving complete closure of the PDA.
Area of Science:
- Cardiology
- Pediatric Interventional Cardiology
- Vascular Surgery
Background:
- Arterial puncture poses significant vascular complication risks, particularly in pediatric patients under 10 kg.
- Minimizing complications in pediatric cardiovascular procedures is a critical clinical objective.
Purpose of the Study:
- To assess a novel percutaneous technique for transcatheter closure of persistent arterial duct (PDA) in infants and small children.
- To evaluate the safety and efficacy of a venous-access-only approach for PDA occlusion.
Main Methods:
- Six pediatric patients (mean weight 8.85 kg) underwent PDA closure using a transvenous approach.
- Occluder placement was confirmed via pulmonary artery angiography and echocardiography.
- The procedure involved implantation of occluders solely through venous access, avoiding arterial puncture.
Main Results:
- The transvenous PDA closure was effective in all six patients.
- Complete duct closure was confirmed immediately post-procedure and during follow-up (mean 9.17 months).
- No stenosis of the pulmonary arteries or aorta was observed; one case of temporary duct constriction resolved upon catheter removal.
Conclusions:
- Transcatheter arterial duct occlusion via venous access is a safe and effective alternative to arterial puncture methods.
- This approach significantly reduces the risk of vascular complications in small children undergoing PDA closure.
- Potential complications include transient duct constriction due to extensive manipulation.
Introduction:
There is quite high risk of vascular complications connected with arterial puncture - mainly in the group of the smallest patients weighing less than 10 kg.
Aim:
To evaluate a new method of percutaneous closure of persistent arterial duct (PDA) in small children.
Material And Methods:
Six patients were enrolled in this method of PDA closure at the age of 10.67 ±1.97 months. The mean weight was 8.85 ±0.66 kg. The occluders were implanted using only venous access. The position of the occluder was determined by angiography in the pulmonary artery through the delivery system and by echocardiography.
Results:
The procedure was effective in all six cases but we managed to proceed in the planned transvenous method in five cases. There was one case of complete duct constriction after introduction of the catheter, so precise measurements were impossible. After removal of the catheter the constriction remitted completely. The duct was closed in the standard manner. During echocardiographic examination we found complete closure of all six arterial ducts directly after the procedures and in the follow-up (9.17 ±3.02 months). No stenosis within the pulmonary arteries or aorta were found.
Conclusions:
Transcatheter arterial duct occlusion without arterial puncture is an effective and safe method of treatment allowing one to reduce the complications connected with arterial puncture. A possible complication of this method may be a constriction of the duct walls as a result of a larger amount of manipulations.
